Predictors of Spontaneous Reverse Remodeling in Mild Heart Failure Patients with Left Ventricular Dysfunction
Background—There are limited data regarding factors associated with spontaneous left ventricular reverse remodeling (S-LVRR) among mildly symptomatic heart failure (HF) patients and its prognostic implications on clinical outcomes.
Methods and Results—Best subsets logistic regression analysis was used to identify factors associated with SLVRR (defined as ≥ 15% reduction in left ventricular end systolic volume at 1-year of follow-up) among 612 patients treated with internal cardioverter defibrillator (ICD)-only therapy in MADIT-CRT, and to create a score for the prediction of S-LVRR. Cox proportional hazards regression modeling was used to assess the clinical outcome of all ICD-only patients (n = 714) with a high S-LVRR score. S-LVRR occurred in 25% of ICD-only patients. Predictors of S-LVRR included: systolic blood pressure ≥ 140 mmHg, serum creatinine <1.0 mg/dl, QRS 130-160 msec, and non-ischemic cardiomyopathy. Multivariate analysis showed that each one point increment in S-LVRR score (range: 0-7) was associated with an 11% (p = 0.019) reduction in the risk of heart failure (HF) or death. Treatment with CRT-D was associated with a significant reduction in the risk of HF or death only among ICD-treated patients with a low (Q1-3) S-LVRR score (HR = 0.55; p < 0.001), but not among those with a higher (Q4) score (HR = 1.06; p = 0.72).
Conclusions—Our data suggest that approximately one quarter of mild HF patients eligible for biventricular pacing experience S-LVRR. Combined assessment of clinical factors associated with S-LVRR can be used to identify mild HF patients with a low risk for clinical events without CRT intervention.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
- Received July 14, 2013.
- Accepted April 9, 2014.